A University-Level Mindfulness Peer Education Program: Development and Evaluation Outcomes

Introduction

In 2024, the National College Health Assessment of 24,473 students from 38 universities found that 78% reported moderate to high stress and 41.2% had a mental health disorder commonly related to anxiety (31.5%), depression (24.1%), and trauma (7.0%) (American College Health Association, 2024). It has been documented that college students experience high stress levels due to different sources, including academic, interpersonal, financial, and career-planning stressors (Beiter et al., 2015; Britt et al., 2017; Karaman et al., 2019). Notably, the prevalence of college student stress is increasing (Knapstad et al., 2021). Additionally, college students who reported experiencing chronic stress were significantly more likely to utilize frequent maladaptive health behaviors (Dalton & Hammen, 2018). Thus, effective opportunities for stress management to promote health and wellness are crucial for college students.

Mindfulness has been conceptualized as an approach to experience the present moment with a sense of nonjudgment and acceptance, fostering a state of open awareness (Kabat-Zinn, 2015). Dvořáková and colleagues (2019) postulated that mindfulness training could be used as a preventative tool to support college students through the transition to higher education and to manage stress-related symptoms. It was found that students with higher levels of trait mindfulness, the use of mindfulness in daily life, were more likely to have less self-reported stress and better emotional wellbeing during their first year of college (Kingery et al., 2020). Furthermore, it has been suggested that mindfulness training could improve trait mindfulness over time (Kiken et al., 2016), which could be useful for alleviating student stress during the transition to college and throughout their academic endeavors.

Ample research supports the use of mindfulness practice as a coping strategy for college students struggling with anxiety, depression, and stress (Bamber & Schneider, 2016; Cherry & Wilcox, 2020; Dawson et al., 2020; Halladay et al., 2019; Koppenborg et al., 2022). Meta-analyses of mindfulness interventions for college students have found significant improvements in anxiety (Bamber & Morpeth, 2019) and depression (Ma et al., 2019), both with pooled moderate effect sizes. Narrative reviews of qualitative studies concluded that college students found mindfulness-based interventions to be helpful for managing anxiety, stress, relationships, learning, and self-care (Bamber & Schneider, 2022; Crowther et al., 2020). Additional studies with college student samples demonstrated that mindfulness-based interventions increased life satisfaction (Dvořáková et al., 2017, 2022), decreased sleep problems (Greeson et al., 2014), improved interpersonal competencies (Huerta et al., 2021), and were positively associated with resilience (Freligh & Debb, 2019) and self-regulation (MacDonald, 2021).

Mindfulness training has been implemented on college campuses across contexts, such as within student health services (Mahfouz et al., 2018), college courses dedicated to mindfulness practice (de Bruin et al., 2015; Dietrich & Bidart, 2022; Kumar, 2021; Medlicott et al., 2021), and other college courses that integrate mindfulness practices into their content (Chinnery et al., 2019; Miller et al., 2017; Strait et al., 2020; Vilvens et al., 2021). These trainings have provided students with immediate improvements in their biopsychosocial health. Moreover, longitudinal benefits of mindfulness initiatives have been identified on college campuses. For example, students who completed a semester-long mindfulness course, and then continued sessions twice per year, demonstrated increases in wellbeing, dispositional mindfulness, and problem-focused coping abilities six years after completing the course (de Vibe et al., 2018). Another longitudinal study found that students who completed a mindfulness-based intervention sustained significant improvements in self-confidence and evaluation-related anxiety up to 2.5 years post-study (Dundas et al., 2016).

The National Association of Student Personnel Administrators (NASPA) offers peer education program development training for universities hoping to start and maintain peer education programs unique to their campuses to enhance student learning and leadership (NASPA, n.d.). Peer educators in NASPA-affiliated programs are college students who undergo specific training to facilitate health programs for their peers on campus. A National Peer Educator Study by Lemon and Wawrzynski (2023) that included data from 609 peer educators across 450 universities reported the use of peer education program topics with the most common being stress management (49.3%), mental health awareness (49.3%), and self-care (45.6%). Peer educators provide valuable resources that increase access to health education for students in the university setting with trends showing an increase in health peer education training (Wawrzynski & Lemon, 2021).

Research studies have found that peer education programs about mental health (Reis et al., 2021), concussion education for student-athletes (Kneavel et al., 2021), bystander intervention (Morean et al., 2021), sexual health (King et al., 2021; Wong et al., 2019), and sexual assault prevention (Jozkowski et al., 2015) have been implemented on college campuses with success. Relatedly, peer coaches have been recognized as helpful sources of support that connect students with campus resources, foster connections, and provide tools for managing academic stress (Corrigan et al., 2020). In addition, a peer mentoring program was shown to improve health behaviors and cultural self-efficacy for college students (Yan et al., 2014). Likewise, facilitators of college peer education or support programs have reported benefits related to their personal wellbeing, self-efficacy, health knowledge, and professional development in leadership roles (Crisp et al., 2020). Thus, peer education programs yield the potential to positively impact the wellbeing and learning outcomes of both student attendees and facilitators.

Very few studies have examined NASPA-affiliated peer education programs for health and wellness on college campuses; the existing studies have focused on program prevalence, program facilitators, and behavior changes related to learned content (Kneavel et al., 2021; Morean et al., 2021; Reis et al., 2021). To our knowledge, there are no studies that have focused on the peer education program evaluations completed by student attendees directly after program presentations. These evaluations are fruitful sources of information, as they convey attendees’ immediate perspectives regarding the presentation (e.g., presenter effectiveness, learning outcomes, overall enjoyment of the program); thus, they can be used to inform future program facilitation. Therefore, the primary aim of our paper is to share the results of evaluations for a novel mindfulness peer education program to understand the immediate impact of the program on the learning outcomes for college student attendees. The secondary aim is to outline the development of the mindfulness peer education presentation to provide a foundation for universities to implement similar opportunities as part of their peer education curricula.

Methods

Results

Descriptive statistics were calculated using the Statistical Package for the Social Sciences Statistics (SPSS version 28.0.1.1). Missing data were handled by using mean substitution. Means, standard deviations, and ranges for evaluation items 1–10 are presented in Table 2. The average ratings for all 10 items were over 3.0 on the Likert scale, indicating “agree” with each statement. Participants reported the highest agreement mean scores for the learning outcomes of “recognizing the benefits of mindfulness” (3.74 ± 0.23) and “defining mindfulness” (3.67 ± 0.27) as a result of the presentation. The lowest average scores were for the learning outcomes of “intention to change behavior” (3.29 ± 0.61) and “interested in learning more about mindfulness” (3.39 ± 0.59) as a result of the presentation. Twenty-four participants reported that this peer education program was their first exposure to mindfulness (15.7% of sample).

Thematic analysis was used for open-ended feedback. Sixty-two of the participants (47.4% of sample) provided qualitative feedback about the program. All of the activities were mentioned as favorite aspects of the program: body scan (n = 20), Mindful Jar (n = 10), mindful raisin eating (n = 9), gratitude (n = 7), and alternate nostril breathing (n = 6). Additional positive feedback was centered around peer educator facilitation qualities (n = 4; e.g., “The presenter seemed to care a lot about the topic.”), learning more about mindfulness (n = 3; e.g., “I enjoyed finding out more about mindfulness.”), the variety of interactive activities (n = 2; e.g., “How there were activities that were interesting and got the audience involved.”), and the additional resources shared (n = 1; e.g., “Loved all the extra resources at the end of the packet.”). Two suggestions were offered to improve the program: one participant shared that the Mindful Jar activity could be explored “more in-depth,” and one participant reported that a PowerPoint presentation would be a helpful addition.

Discussion

Mindfulness is a powerful practice that has been shown to improve college students’ mental and physical wellbeing. Peer education programs are cost-effective and beneficial to both attendees and facilitators, and they may be a useful way to bring mindfulness practices to college campuses in a variety of contexts. We outlined the creation of a mindfulness peer education program implemented at a large midwestern public university with a National Association of Student Personnel Administrators–certified peer education curriculum, and we reviewed attendee evaluations from the program’s first year on campus. Results indicated a generally positive response to the program, as all learning outcomes were rated above 3.0 on a 4.0 Likert scale. This outcome indicated that, on average, students agreed with the evaluation items that they could think critically about mindfulness, learned new skills for stress management, reflected on their experience, were interested in continued learning, would recommend this presentation, and viewed the facilitators as effective. An important aspect to note is that the facilitators were different pairs of certified peer educators for each presentation due to the structure of the peer education program at this university; the attendees’ rating of presenter effectiveness was therefore indicative of the effectiveness of this university’s peer education training as multiple peer educators were presenting the same material across campus effectively. Most of the participants indicated that they had heard about mindfulness before the presentation, which is not surprising as the popularity of mindfulness practice has been increasing in the United States since the 1990s (Simonsson et al., 2020). Rizer et al. (2016) found that college students who reported greater perceived benefits of mindfulness were more likely to engage in mindfulness practice. Thus, sharing the research related to mindfulness practice for college students, as was done in this mindfulness peer education presentation, may be important when informing students about using this health-enhancing practice in their daily life.

To our knowledge, no previous study has investigated the learning outcomes from a NASPA-affiliated peer education program in a university setting. The National Association of Student Personnel Administrators, the national certifying board for health peer education programs, recommends that evaluation of peer education processes, outcomes, and university-wide impacts be documented to support the current necessity and work of peer educators and to inspire future initiatives (Czachowski, 2023). Peer education programs are useful approaches for sharing health information because attendees are sometimes more comfortable connecting with peers (rather than unknown health professionals) due to the shared identities and roles of being current college students (Wong et al., 2019). Therefore, as peer education programs continue to be offered on college campuses as approachable ways to provide students with health information, the learning outcomes of program attendees must be assessed and documented, as we did here, to learn more about the true implications of using peer education.

Our study has implications for further research that can improve the methodology. Future studies could use assessment tools that are more reliable to better examine the impacts of peer education presentations on attendee learning outcomes. We used the evaluation form that was already in place for peer education programs at this particular university; however, future studies could work with peer education programs to implement assessment tools that have good psychometric properties. Similarly, the open structure for written evaluation about favorite program aspect and additional program feedback can pose a barrier to more complete data collection. Very few attendees took the time to write a response here. Open-response questions increase the time and effort of responders, which may lead to higher non-response rates (Schmidt et al., 2020). Future evaluations could alternatively use, for example, a multiple-choice format for favorite activity rather than an open response format. Additionally, larger sample sizes may include a broader range of participant demographics in order to better examine cultural relevance of mindfulness peer education programs beyond the demographics included in our sample.

Another research approach could involve conducting a follow-up study to determine whether the attendees continued to use any of the mindfulness activities, developed a mindfulness practice, or sought out additional resources to measure the extent of this peer education presentation on student behavior and learning. This follow-up study could be done via a short survey or brief interviews to better understand the longer-term impacts of the mindfulness peer education presentation. Lastly, only seven mindfulness peer education presentations were included in this analysis. During the first year of this program’s implementation on campus, COVID-19 interrupted in-person presentations and data collection. Peer education at this university was transformed to include recorded presentations available to view anytime on YouTube. As Bowling et al. (2021) found, virtual peer education programs come with both benefits (e.g., greater accessibility, self-paced learning, increased sense of comfort discussing difficult topics online versus in person) and challenges (e.g., event planning, distribution of health products, opportunities for social connection) for peer educators and student attendees. Thus, adaptations to the mindfulness presentation itself would be interesting to document for improving accessibility, reaching more students, and identifying what facilitation approaches work and why (e.g. online versions since living in COVID-19 world, inclusion of visual prompts like PowerPoint presentations as suggested by one of the participants in our study).

The mindfulness peer education activities outlined here are versatile, adaptable to the practitioner, and have yielded positive impacts on biopsychosocial outcomes in previous studies. These activities aimed to promote embodied experiences of mindfulness techniques, introspection, reflective thinking, and connection through sharing and listening to participants’ experiences in the group. Moreover, the activities demonstrated how mindfulness can be brought to typical daily actions (e.g., eating and breathing) so that college students could easily integrate mindfulness practice into their busy schedules. Mindfulness that is intentionally incorporated into daily activities has been shown to improve dispositional mindfulness as well as positive and negative affect in a sample of college students (Hanley et al., 2015). These researchers proposed that informal mindfulness practices through daily activities may be a more accessible way to offer mindfulness practice to students.

Conclusion

The National Peer Educator Study did not include mindfulness in the 26 total programs that participating universities reported as part of their peer education curriculum (Lemon & Wawrzynski, 2023). Based on the documented benefits of mindfulness for college student health and personal development, mindfulness may be a topic that universities could easily add to their peer education programs. Our study might serve as a foundation for universities to create mindfulness presentations for their peer education curricula. Likewise, this evaluation study can motivate future research about peer education programs to glean better insight about the impacts of these opportunities on college campuses.

Competing Interests

The authors have no competing interests to declare.